'It is a biological fact of life that we cannot avoid getting cancer as we
get older,' said Professor Gotzche

What could be more sensible than having a mammogram?

If a tiny tumour is growing in your breast, you want to find it as soon as
possible and treat it before it has a chance to spread and become
life-threatening.

This simple idea is the basis of a worldwide breast scanning industry that
costs billions every year.

The UK programme was launched in 1988, and according to triumphant figures
released last week it is screening more women than ever before — nearly
1.9million a year (at a cost of around £96 million).

‘By bringing forward detection and diagnosis, screening helps us find those
cancers that might otherwise not be caught until later in life,’ said Sarah
Sellars, assistant director for the NHS Cancer Screening Programmes.

However, some experts question whether national screening programmes for
breast cancer are such a good idea.

For more than a decade, Peter Gotzsche, a leading Danish professor and
statistician, has argued they are a serious mistake: not only do they do little
to reduce the death rate from breast cancer, but because women haven’t been told
the truth about the risks of mammography, some endure painful disfigurement and
completely unnecessary treatment that may have shortened their lives.

Two years ago, when he looked at the figures produced to mark the 20th
anniversary of the UK screening programme, Professor Gotzsche’s analysis
suggested that for every 2,000 women screened regularly for ten years, just one
will benefit from the screening.

At the same time, ten healthy women will, as a consequence, become cancer
patients and be treated unnecessarily.

Rather than one life being saved for every ten women who received unnecessary
treatment, she says, the true figure was much closer to a one-to-one ratio.

But Gotzsche has blue-chip credentials — he is professor of clinical research
design and analysis and leader of the Nordic Cochrane Center at Rigshospitalet
in Copenhagen, and an expert in the statistics needed to assess the risks and
benefits of screening.

Once a mammogram picks up something that might be a tumour, you're on
your way to becoming a cancer patient

Yet for almost ten years there has been a concerted campaign to discredit
him, while scanning authorities in the UK, U.S. and Europe have done little to
address his criticisms.

Many women will be vaguely aware that recently there have been some
criticisms of mammograms.

Some may recall the news last October that the NHS leaflet on scanning given
to women is to be reviewed following claims it exaggerated benefits and did not
spell out the risks.

Analysis of the problems quickly becomes technical and is only available in
hard-to-obtain, specialist journals.

Which is why Professor Gotzsche has written a book, Mammography Screening:
Truth, Lies And Controversy.

He claims there has been a shocking campaign by the authorities to keep his
alternative analysis from women.

The first time he raised concerns was in 2000.

Professor Gotzsche set out his case in an explosive article in the medical
journal The Lancet.

Based on analysis of the results of the screening programme in Sweden it
concluded mammography was ‘unjustified’ — and it generated a furious response.

Experts in the screening industry expressed ‘dismay’ that it would erode
public confidence in screening and urged women to ignore it.

The Department of Health issued a press release saying the NHS Breast
Screening programme was a success and there was no new evidence in The Lancet
report.

‘Our review was described as riddled with misrepresentations, inconsistencies
and errors of method and fact,’ says Professor Gotzsche.

‘But often the attacks didn’t even challenge my research — they were simply
personal. I was said to be ignorant, careless and on a crusade against
screening.’

His report was originally commissioned by the Danish Board of Health, but
when it was delivered the board tried to classify it as a ‘non-paper’, so it
couldn’t even be accessed through the country’s Freedom of Information Act.

One of Professor Gotzsche’s chief opponents, Laszlo Tabar, was the author of
one of the Swedish trials analysed in The Lancet.

He claimed it showed scanning to be effective and safe and still holds that
view.

Recently Tabar said scanning was the best thing to happen for women in 3,000
years, adding: ‘There are still people who don’t like mammography.

But what can be wrong with checking to catch breast cancer as early as
possible?

If every tumour that showed up on a mammogram eventually spread around the
body, no one could object. But cancer isn’t like that.

‘It is a biological fact of life that we cannot avoid getting cancer as we
get older,’ says Professor Gotzsche.

‘It’s so common nearly all middle-aged people will have some sign of it and
most of them will die without having had any symptoms as a result.’

In other words, scanning finds cancerous changes that would otherwise never
have caused a problem in your lifetime.

But once a mammogram picks up something that might be a tumour, you’re on
your way to becoming a cancer patient because there are no reliable ways of
telling if you’ve got the slow-growing or disappearing type, or if it is going
to become dangerously invasive.

You will be sent for a biopsy and, if it’s cancerous, you get the full cancer
works — surgery, chemotherapy and radiation, and possibly have your breast
removed.

Thousands who would otherwise have remained perfectly healthy — because their
cancers would never have caused a problem — become cancer patients.

In his book, Professor Gotzsche quotes a British woman who described what it
could involve.

Her scan found a carcinoma in situ — a type of cancerous change in a cell
that, in most cases, does not develop into the potentially lethal, invasive form
of the disease.

'Two wide excisions, one partial mutilation (sorry, mastectomy), one
reconstruction, five weeks’ radiotherapy, chronic infection, four bouts of
cellulitis (a bacterial skin infection), several general anaesthetics, and more
than a year off work.’

Thousands of women don’t go through anything as gruelling, but the sheer
number overdiagnosed comes as a shock.

Professor Gotzsche has calculated that each year about 70,000 British women
are recalled after a ‘false positive’ mammogram result.

In some cases, the cell changes detected by the mammogram weren’t cancerous.

But Professor Gotzsche is really concerned about cells that are cancerous but
would never have caused problems.

Known as overdiagnosed cancers, they result in women treated unnecessarily.

Working out how many women had this unnecessary treatment is very
complicated, which is why the debate gets so fierce.

‘The crucial question is, how many lives does it save?’ Professor Gotzsche
adds.

‘Is it enough to justify the harms inflicted on the healthy population?’

The screening programme officially saves an estimated 1,400 lives every year,
but the professor found this couldn’t be true.

By using these figures, says Professor Gotzsche, the NHS has failed to give
women honest information on which to make a decision and that just one life is
saved while 10 women will be treated unnecessarily.

‘What is remarkable to me,’ wrote one, ‘is that this man calls himself a
scientist since he obviously, knowingly ignores the scientific method to further
his own agenda. I cannot believe his is so intellectually deficient.’

Professor Gotzsche has never said women shouldn’t be scanned — he believes
women should get a realistic estimate of the benefits and risk, which, right
now, they aren’t. That, he says, is a scandal.